Objective:To investigate the value of preoperative intestinal ultrasound parameters in predicting early postoperative recurrence（EPR）in patients with Crohn's disease（CD）.Methods:Ninety-five patients with CD who underwent I-stage intestinal resection at the Sixth Affiliated Hospital， Sun Yat-sen University from March 2015 to December 2020 were retrospectively enrolled. The patients were divided into EPR group （ n=50） and non-EPR （NEPR） group （ n=45） based on recurrence within one year postoperatively. Differences in preoperative intestinal ultrasound parameters including bowel wall thickness，bowel wall stratification， color Doppler grading， mesenteric fat hypertrophy （MFH） ， mesenteric lymphadenopathy， abscess/fistula， abdominal effusion， and clinical factors such as preoperative C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） were compared between the two groups. The predictive values of ultrasound parameters with statistically significant differences between the two groups were analyzed. Univariate and multivariate Logistic regression analyses were used to identify independent predictive factors associated with EPR in patients with CD. Results:During the 1-year follow-up，EPR occurred in 52.6%（50/95）patients with CD. Among clinical factors，preoperative CRP and ESR levels showed statistically significant differences between the EPR and NEPR groups（all P<0.05）. For ultrasound parameters，the incidences of mesenteric fat hypertrophy（MFH）and abscess/fistula were significantly higher in the EPR group than the NEPR group（all P<0.05）. MFH demonstrated a significantly higher AUC value for predicting EPR compared to abscess/fistula（0.797 vs.0.617， P=0.002）. Univariate Logistic analysis showed that CRP，ESR，MFH and abscess/fistula were candidate variables for diagnosing EPR（all P<0.05）. Multivariate Logistic regression analysis indicated that MFH（ OR=13.800， P<0.001）and the laboratory measure CRP（ OR=1.015， P=0.030）were effective predictive factors for EPR. Conclusions:Preoperative intestinal ultrasound parameter MFH may serve as a valuable predictor for assessing EPR risk in patients with CD.

Objective:To investigate the value of preoperative intestinal ultrasound parameters in predicting early postoperative recurrence（EPR）in patients with Crohn's disease（CD）.Methods:Ninety-five patients with CD who underwent I-stage intestinal resection at the Sixth Affiliated Hospital， Sun Yat-sen University from March 2015 to December 2020 were retrospectively enrolled. The patients were divided into EPR group （ n=50） and non-EPR （NEPR） group （ n=45） based on recurrence within one year postoperatively. Differences in preoperative intestinal ultrasound parameters including bowel wall thickness，bowel wall stratification， color Doppler grading， mesenteric fat hypertrophy （MFH） ， mesenteric lymphadenopathy， abscess/fistula， abdominal effusion， and clinical factors such as preoperative C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） were compared between the two groups. The predictive values of ultrasound parameters with statistically significant differences between the two groups were analyzed. Univariate and multivariate Logistic regression analyses were used to identify independent predictive factors associated with EPR in patients with CD. Results:During the 1-year follow-up，EPR occurred in 52.6%（50/95）patients with CD. Among clinical factors，preoperative CRP and ESR levels showed statistically significant differences between the EPR and NEPR groups（all P<0.05）. For ultrasound parameters，the incidences of mesenteric fat hypertrophy（MFH）and abscess/fistula were significantly higher in the EPR group than the NEPR group（all P<0.05）. MFH demonstrated a significantly higher AUC value for predicting EPR compared to abscess/fistula（0.797 vs.0.617， P=0.002）. Univariate Logistic analysis showed that CRP，ESR，MFH and abscess/fistula were candidate variables for diagnosing EPR（all P<0.05）. Multivariate Logistic regression analysis indicated that MFH（ OR=13.800， P<0.001）and the laboratory measure CRP（ OR=1.015， P=0.030）were effective predictive factors for EPR. Conclusions:Preoperative intestinal ultrasound parameter MFH may serve as a valuable predictor for assessing EPR risk in patients with CD.

Objective:To investigate the application value of shear wave dispersion (SWD) imaging in evaluating segmental mucosal healing in patients with Crohn's disease (CD) .Methods:Eighty-nine patients who were comprehensively confirmed to have CD by clinical, endoscopic, and pathologic evidence were prospectively evaluated. The affected intestinal segments were divided into mucosal healing and non-mucosal healing groups based on simple endoscopic score for Crohn's disease. The value of shear wave dispersion slope (SWDS) in evaluating mucosal healing was determined using receiver operating characteristic (ROC) curve analysis, and compared with shear wave elastic modulus (SWEM), shear wave velocity (SWS), bowel wall thickness (BWT), bowel wall stratification (BWS), and Limberg classification.Results:There were 24 cases of mucosal healing and 65 cases of non-mucosal healing in the 89 CD patients in this study. There were significant differences in SWDS, SWEM, SWS, BWT, BWS, and Limberg classification between the mucosal healing and non-mucosal healing groups (all P < 0.05). The ROC curve showed that the AUC of SWDS in diagnosing mucosal healing was better than that of BWT, SWEM, and SWS (all P < 0.05), but with no significant differences compared to BWS ( P = 0.28) and Limberg grading ( P = 0.13). At the same time, SWDS combined with BWT could significantly improve the diagnostic performance of BWT for mucosal healing ( P=0.0003) . Conclusion:SWD imaging can serve as an effective complement to routine ultrasound in assessing segmental mucosal healing in patients with CD, and has clinical application value.

Objective:To investigate the application value of shear wave dispersion (SWD) imaging in evaluating segmental mucosal healing in patients with Crohn's disease (CD) .Methods:Eighty-nine patients who were comprehensively confirmed to have CD by clinical, endoscopic, and pathologic evidence were prospectively evaluated. The affected intestinal segments were divided into mucosal healing and non-mucosal healing groups based on simple endoscopic score for Crohn's disease. The value of shear wave dispersion slope (SWDS) in evaluating mucosal healing was determined using receiver operating characteristic (ROC) curve analysis, and compared with shear wave elastic modulus (SWEM), shear wave velocity (SWS), bowel wall thickness (BWT), bowel wall stratification (BWS), and Limberg classification.Results:There were 24 cases of mucosal healing and 65 cases of non-mucosal healing in the 89 CD patients in this study. There were significant differences in SWDS, SWEM, SWS, BWT, BWS, and Limberg classification between the mucosal healing and non-mucosal healing groups (all P < 0.05). The ROC curve showed that the AUC of SWDS in diagnosing mucosal healing was better than that of BWT, SWEM, and SWS (all P < 0.05), but with no significant differences compared to BWS ( P = 0.28) and Limberg grading ( P = 0.13). At the same time, SWDS combined with BWT could significantly improve the diagnostic performance of BWT for mucosal healing ( P=0.0003) . Conclusion:SWD imaging can serve as an effective complement to routine ultrasound in assessing segmental mucosal healing in patients with CD, and has clinical application value.

With the progress of disease diagnosis and treatment, the treatment goals of Crohn′s disease have evolved from clinical remission to mucosal healing, and ultimately towards transmural healing. Accumulating evidence suggests a good association between transmural healing and a better long-term outcome. However, the definition and evaluation criteria of transmural healing reported in literatures are not uniform at present. The bowel wall thickness ≤3 mm with or without normal color doppler signal assessed by doppler ultrasound is regarded as the criterion of transmural healing in most of studies. Although other parameters of conventional ultrasound (bowel wall stratification and inflammatory mesenteric fat) and new ultrasound techniques (contrast enhanced ultrasound and ultrasound elastic imaging) are related to inflammatory activity to a certain extent, there is no sufficient evidence to prove their value in evaluating transmural healing. We suggest that normal bowel wall thickness and bowel wall flow should be used as the criteria for evaluating transmural healing.

With the progress of disease diagnosis and treatment, the treatment goals of Crohn′s disease have evolved from clinical remission to mucosal healing, and ultimately towards transmural healing. Accumulating evidence suggests a good association between transmural healing and a better long-term outcome. However, the definition and evaluation criteria of transmural healing reported in literatures are not uniform at present. The bowel wall thickness ≤3 mm with or without normal color doppler signal assessed by doppler ultrasound is regarded as the criterion of transmural healing in most of studies. Although other parameters of conventional ultrasound (bowel wall stratification and inflammatory mesenteric fat) and new ultrasound techniques (contrast enhanced ultrasound and ultrasound elastic imaging) are related to inflammatory activity to a certain extent, there is no sufficient evidence to prove their value in evaluating transmural healing. We suggest that normal bowel wall thickness and bowel wall flow should be used as the criteria for evaluating transmural healing.

Periodontitis is a widespread oral disease characterized by continuous inflammation of the periodontal tissue and an irreversible alveolar bone loss, which eventually leads to tooth loss. Four-octyl itaconate (4-OI) is a cell-permeable itaconate derivative and has been recognized as a promising therapeutic target for the treatment of inflammatory diseases. Here, we explored, for the first time, the protective effect of 4-OI on inhibiting periodontal destruction, ameliorating local inflammation, and the underlying mechanism in periodontitis. Here we showed that 4-OI treatment ameliorates inflammation induced by lipopolysaccharide in the periodontal microenvironment. 4-OI can also significantly alleviate inflammation and alveolar bone loss via Nrf2 activation as observed on samples from experimental periodontitis in the C57BL/6 mice. This was further confirmed as silencing Nrf2 blocked the antioxidant effect of 4-OI by downregulating the expression of downstream antioxidant enzymes. Additionally, molecular docking simulation indicated the possible mechanism under Nrf2 activation. Also, in Nrf2^-/- mice, 4-OI treatment did not protect against alveolar bone dysfunction due to induced periodontitis, which underlined the importance of the Nrf2 in 4-OI mediated periodontitis treatment. Our results indicated that 4-OI attenuates inflammation and oxidative stress via disassociation of KEAP1-Nrf2 and activation of Nrf2 signaling cascade. Taken together, local administration of 4-OI offers clinical potential to inhibit periodontal destruction, ameliorate local inflammation for more predictable periodontitis.
Alveolar Bone Loss/prevention & control* ; Animals ; Antioxidants/pharmacology* ; Inflammation ; Kelch-Like ECH-Associated Protein 1/metabolism* ; Mice ; Mice, Inbred C57BL ; Molecular Docking Simulation ; NF-E2-Related Factor 2/metabolism* ; Periodontitis/prevention & control* ; Succinates

Objective:To explore the effect of timing of infliximab (IFX) treatment on transmural healing (TH) in Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. Consecutive adult patients with active CD prescribed IFX in the Sixth Affiliated Hospital of Sun Yat-sen University from Janurary to September 2019 were recruited. Patients underwent intestinal ultrasound evaluation at baseline and 14 weeks after IFX initiation. According to the time from diagnosis to IFX initiation, patients were divided into early therapy group (≤12 months) and late therapy group (>12 months) . The differences of transmural healing (TH) and mucosal healing (MH) at 14th week between 2 groups were analyzed. TH was defined as bowel wall thickness (BWT) ≤3 mm in any segments, with normal stratification and bowel wall vascularity, and without mesenteric fat proliferation. MH was defined as the simplified endoscopic score for CD≤2 points and without ulceration.Results:Fifty-four patients were enrolled, including 28 in early therapy group and 26 in late therapy group, and there were no significant differences in baseline BWT[6.0 (5.3, 7.0) mm vs. 7.0 (5.0, 8.0) mm, Z = -0.668, P = 0.504] and simplified endoscopic score for CD[ (12.86 ± 9.26) points vs. (12.89 ± 7.46) points, t = -0.012, P = 0.991] between the two group. At 14th week, the decrease of BWT [3.0 (1.3, 3.0) mm vs. 1.0 (0, 2.0) mm, Z = -2.922, P = 0.003], the rate of TH [39.3% (11/28) vs. 11.5% (3/26) , χ 2 = 5.405, P = 0.020] and MH [52.2% (12/23) vs. 20.8% (5/24) , χ 2 = 4.997, P = 0.025] in early therapy group were significantly higher than those in late therapy group, respectively. Conclusion:Compared with late initiation of IFX treatment after diagnosis, patients with CD who initiate IFX treatment earlier are more likely to achieve TH.

Objective:To explore the effect of timing of infliximab (IFX) treatment on transmural healing (TH) in Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. Consecutive adult patients with active CD prescribed IFX in the Sixth Affiliated Hospital of Sun Yat-sen University from Janurary to September 2019 were recruited. Patients underwent intestinal ultrasound evaluation at baseline and 14 weeks after IFX initiation. According to the time from diagnosis to IFX initiation, patients were divided into early therapy group (≤12 months) and late therapy group (>12 months) . The differences of transmural healing (TH) and mucosal healing (MH) at 14th week between 2 groups were analyzed. TH was defined as bowel wall thickness (BWT) ≤3 mm in any segments, with normal stratification and bowel wall vascularity, and without mesenteric fat proliferation. MH was defined as the simplified endoscopic score for CD≤2 points and without ulceration.Results:Fifty-four patients were enrolled, including 28 in early therapy group and 26 in late therapy group, and there were no significant differences in baseline BWT[6.0 (5.3, 7.0) mm vs. 7.0 (5.0, 8.0) mm, Z = -0.668, P = 0.504] and simplified endoscopic score for CD[ (12.86 ± 9.26) points vs. (12.89 ± 7.46) points, t = -0.012, P = 0.991] between the two group. At 14th week, the decrease of BWT [3.0 (1.3, 3.0) mm vs. 1.0 (0, 2.0) mm, Z = -2.922, P = 0.003], the rate of TH [39.3% (11/28) vs. 11.5% (3/26) , χ 2 = 5.405, P = 0.020] and MH [52.2% (12/23) vs. 20.8% (5/24) , χ 2 = 4.997, P = 0.025] in early therapy group were significantly higher than those in late therapy group, respectively. Conclusion:Compared with late initiation of IFX treatment after diagnosis, patients with CD who initiate IFX treatment earlier are more likely to achieve TH.

With the progress of disease diagnosis and treatment, the treatment goals of Crohn′s disease have evolved from clinical remission to mucosal healing, and ultimately towards transmural healing. Accumulating evidence suggests a good association between transmural healing and a better long-term outcome. However, the definition and evaluation criteria of transmural healing reported in literatures are not uniform at present. The bowel wall thickness ≤3 mm with or without normal color doppler signal assessed by doppler ultrasound is regarded as the criterion of transmural healing in most of studies. Although other parameters of conventional ultrasound (bowel wall stratification and inflammatory mesenteric fat) and new ultrasound techniques (contrast enhanced ultrasound and ultrasound elastic imaging) are related to inflammatory activity to a certain extent, there is no sufficient evidence to prove their value in evaluating transmural healing. We suggest that normal bowel wall thickness and bowel wall flow should be used as the criteria for evaluating transmural healing.